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- W2978164583 abstract "Purpose: GI bleeding is a fairly common initial presentation to both outpatient and inpatient services. One cause that has been increasingly appreciated is an arteriovenous malformation associated with a Left Ventricular Assist Device (LVAD). A 49 year male presented to our institution with one month of left upper quadrant pain and several weeks of black tarry stools. He had never had an endoscopy/colonoscopy nor been diagnosed with gastrointestinal bleeding in the past. Our patient had a Heartmate II LVAD placed four months prior. He had been taking ASA and coumadin with a therapeutic INR as well as a proton pump inhibitor since LVAD placement. Upper endoscopy revealed a non-bleeding AVM in the upper body of the stomach as well as several areas of focal gastric erythema. No duodenal pathology was appreciated. The gastric AVM was treated with argon plasma coagulation (APC). No pathology was noted on colonoscopy. The patient continued ASA and Coumadin without recurrent evidence of bleeding. Our patient's arteriovenous malformation was secondary to LVAD insertion. Despite commonly appreciated severe bleeding in patients with mechanical circulatory support our patients bleeding was mild without any hemodynamic compromise. One of the first to document the association of LVAD treatment and AVM based bleeding was Letsou, et al in 2005. Since that time there has been an increase in the literature suggesting a direct association of mechanical circulatory support and GI tract bleeding. Those lesions documented in the literature have been noted to be arteriovenous malformations such as our patient. It seems there is an inherent risk of AVMs forming in those with LVAD therapy. It has been proposed by Letsou, et al, that the lack of pulsatility and thus changes in the physiologic pulse pressure usually placed on venous and arterial walls is causal for the increased development of AVMs. There has been appreciated a propensity in those with LVADs to develop an acquired von Willebrands disorder. This acquired disorder is almost identical to that seen in aortic stenosis where the high-molecularweight multimers (HMWM) of von Willebrands factor are at a decreased concentration in the serum.Figure" @default.
- W2978164583 created "2019-10-10" @default.
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- W2978164583 date "2011-10-01" @default.
- W2978164583 modified "2023-09-26" @default.
- W2978164583 title "Ventricular Assist Device related Arteriovenous Malformation" @default.
- W2978164583 doi "https://doi.org/10.14309/00000434-201110002-00521" @default.
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